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Public Health Statement for Perfluoroalkyls

This Public Health Statement is the summary chapter from the Toxicological Profile for Perfluoroalkyls. It is one in a series of Public Health Statements about hazardous substances and their health effects. A shorter version, the ToxFAQsTM, is also available. This information is important because these substances may harm you. The effects of exposure to any hazardous substance depend on the dose, the duration, how you are exposed, personal traits and habits, and whether other chemicals are present. For more information, call the ATSDR Information Center at 1 800-232-4636.

This public health statement tells you about perfluoroalkyls and the effects of exposure to them.

When a substance is released either from a large area, such as an industrial plant, or from a container, such as a drum or bottle, it enters the environment. Such a release does not always lead to exposure. You can be exposed to a substance only when you come in contact with it. You may be exposed by breathing, eating, or drinking the substance, or by skin contact. Most human exposures to perfluoroalkyls are to PFOA and PFOS. Most human exposures to perfluoroalkyls are expected to be through contaminated food and drinking water.

If you are exposed to perfluoroalkyls, many factors will determine whether you will be harmed. These factors include the dose (how much), the duration (how long), and pathway (how you contact the perfluoroalkyls). Other important factors are any other chemicals you are exposed to, your age, sex, diet, family traits, lifestyle, and state of health.

1.2 What happens to Perfluoroalkyls when they enter the environment?

Releases to the environment

Perfluoroalkyls are not found naturally in the environment, but are there because of the action of humans. Perfluoroalkyls can be released into the environment when facilities and people use products that contain them. Perfluoroalkyls have been released into the environment near facilities that made or used these substances, and in many cases, contaminated the groundwater. These types of releases appear to be decreasing based on reports provided by these facilities.

Perfluoroalkyls may be formed in the environment when other related chemicals degrade.

Break down

Air

Perfluoroalkyls break down very slowly in air, but are expected to fall out of the air to the ground within days to weeks.

Water

Perfluoroalkyls are very stable in water and are not known to break down in water. These chemicals may be carried over great distances by ocean currents.

Soil

Perfluoroalkyls are not known to break down in soil. These substances may be carried through soil by groundwater.

1.3 How might I be exposed to perfluoroalkyls ?

Perfluoroalkyls have been widely found in human blood, indicating that human exposure to these substances is common.

Air

Perfluoroalkyls have been found in both air and dust.

You may be exposed to perfluoroalkyls by breathing air containing these substances. Ingestion of dust may also be a source of exposure.

Water and soil

Perfluoroalkyls have been found in surface water, groundwater, soil, and sediment, especially near facilities that have made or used these substances. They have also been found at remote locations such as the Arctic and the open ocean.

Drinking water contaminated with PFOA released from a nearby fluorochemical facility was found to be a major source of exposure to that substance.

Perfluoroalkyls have also been detected in bird eggs, fish, polar bears, etc.

Food and human breast milk

In addition to drinking water, food is expected to be an important source of exposure to perfluoroalkyls based on the amounts found in food samples.

Human breast milk may contribute to the exposure of infants to perfluoroalkyls since these substances have been detected in human breast milk.

Consumer products

Perfluoroalkyls have been widely used in many consumer products (see Section 1.1).

The presence of these substances in carpet treatments could be an important source of exposure to perfluoroalkyls, especially for children.

Workplace

People who work where perfluoroalkyls are made or used may be exposed to these substances.

Levels of PFOS and PFOA measured in the blood of some people who have worked at these locations were higher than levels in people from the same communities who did not work at these locations.

Workplace exposure may also occur for people with jobs that require frequent handling or use of perfluoroalkyls.

1.4 How can perfluoroalkyls enter and leave my body?

Enter your body

Inhalation

When you breathe air containing perfluoroalkyl compounds, some will enter your body through your lungs, but there is limited information on how fast, how much, or what specific perfluoroalkyl may preferentially enter the body

Ingestion

Perfluoroalkyl compounds in food or water may enter your body through the digestive tract.

Dermal contact

If your skin comes into contact with dusts or aerosols of perfluoroalkyl, or with liquids containing perfluoroalkyls, it is possible that a small amount may enter the body through your skin.

Leave your body

Once in your body, perfluoroalkyls tend to remain unchanged for long periods of time. The most commonly used perfluoroalkyls (PFOA and PFOS) stay in the body for many years. It takes approximately 4 years for the level in the body to go down by half, even if no more is taken in. It appears that, in general, the shorter the carbon-chain length, the faster the perfluoroalkyl leaves the body. PFOA, PFOS, PFHxS, and PFNA are measureable in the serum of most U.S. citizens.

1.5 How
can perfluoroalkyls affect my health?

Workers

Inhalation/dermalï¿½Long-term exposure to perfluoroalkyls at work has not been associated with significant adverse health effects, but two studies in workers found changes in sex hormones and cholesterol associated with the levels of PFOA in blood.

General population

Little research has been done on the general population to answer the question of whether perfluoroalkyls may be associated with adverse health effects.

Ingestionï¿½A single study of people whose drinking water contained perfluoroalkyls did not find problems in a number of clinical measures tested. The study did not, however, examine developmental risks for children or cancer. The 326-person study was too small to address these issues.

Laboratory animals

One way to learn about the effects of perfluoroalkyls is to see how they affect test animals.

Inhalationï¿½Short-term exposure of rats to very high levels of PFOA has caused irritation of the eyes and the nose.

Short-term exposure of rats to lower levels of PFOA caused damage to the liver and weight loss.

Ingestionï¿½Feeding food or capsules containing perfluoroalkyls to animals mainly produced alterations in the liver of the animals. It also reduced their growth, possibly because these chemicals affect the way the body processes food the animals eat.

Dermalï¿½Short-term application of large amounts of PFOA to the skin of animals has caused skin irritation and changes in the liver. These liver effects indicate that PFOA can be absorbed into the body through the skin and affect other parts of the body.

Cancer

The information available does not prove that perfluoroalkyls cause cancer in humans, but the evidence is not conclusive. Some increases in prostate and bladder cancer have been seen, but the cause is not certain.

Feeding PFOA and PFOS to rats caused them to develop tumors. Some scientists believe that based on the way this happens in rats, and the differences between rats and humans, humans would not be expected to get cancer. Others believe that it is possible for perfluoroalkyls to cause cancer in humans, and the studies in rats should not be dismissed. More research is needed to clarify this issue.

The International Agency for Research on Cancer and the Department of Health and Human Services have not yet evaluated the carcinogenicity of perfluoroalkyls. The EPA has begun an evaluation.

1.6 How can perfluoroalkyls affect children?

This section discusses potential health effects in humans from exposures during the period from conception to maturity at 18 years of age.

Effects in children

A study of people, including children, in an area of southeastern Ohio, whose drinking water was contaminated with PFOA found no short-term adverse health effects associated with PFOA. However, the study found the highest levels of PFOA in the blood of young children and older adults. The study did not look for cancer or delays in childhood development. The levels of PFOA in the blood from these people were much higher than those found in the general population of the United States.

Three studies of pregnant women found that as the levels of PFOA in the motherï¿½s blood increased there was a tendency for the newborn babies to have slightly lower birth weight. However, another study that looked at exposure to PFOA in drinking water did not find such an association. Based on both animal and human study reports, developmental effects are the greatest concern in regards to potential adverse effects from PFOA exposure.

Laboratory animals

One way to learn about the effects of perfluoroalkyls is to see how they affect test animals.

Birth defects were seen in mice born to females exposed to relatively high amounts of PFOS during pregnancy.

Exposure to PFOA and PFOS has resulted in increased early death and delayed development of mice and rat pups, but this did not occur in animals exposed to PFBA or PFHxS.

Breast milk

Perfluoroalkyl compounds have been found in the breast milk of women, but there are no studies that looked at whether the health of the babies was affected by drinking this milk. Levels of perfluoroalkyls in breast milk are much lower than in the motherï¿½s blood indicating that these substances are not concentrated during the production of motherï¿½s milk.

1.8 Is there a medical test to determine whether i have been exposed to perfluoroalkyls?

Detecting exposure

Perfluoroalkyl compounds can be measured in blood, but this is not a routine test that can be performed in a doctorï¿½s office. You should, however, see a physician if you believe that you have been exposed to high levels of perfluoroalkyls.

Perfluoroalkyls have been measured in blood samples from a representative sample of the U.S. general population; mean serum PFOA and PFOS concentrations were reported to be 3.9 and 20.7 ï¿½g/L, respectively.

Elevated serum PFOA levels were reported in Little Hocking, Ohio, community residents who had environmental exposure to PFOA from a nearby industrial facility through contaminated drinking water; the median serum PFOA concentration was 354 ï¿½g/L.

The presence of perfluoroalkyl compounds in your blood may indicate that you have been exposed to and absorbed perfluoroalkyls into your body.

The presence of perfluoroalkyl compounds in your blood does not necessarily mean that you will suffer adverse health effects. Additional studies are needed to help determine the health effects associated with exposure to perfluoroalkyls. There are a number of studies underway that should help to answer questions about the health effects of perfluoroalkyls.

1.9 What recommendations has the federal government made to protect human health?

The federal government develops regulations and recommendations to protect public health. Regulations can be enforced by law. The EPA, the Occupational Safety and Health Administration (OSHA), and the Food and Drug Administration (FDA) are some federal agencies that develop regulations for toxic substances. Recommendations provide valuable guidelines to protect public health, but cannot be enforced by law. The Agency for Toxic Substances and Disease Registry (ATSDR) and the National Institute for Occupational Safety and Health (NIOSH) are two federal organizations that develop recommendations for toxic substances.

Regulations and recommendations can be expressed as doses, intakes, or amounts in air, water, and food that are expected to be safe, usually based on levels that affect animals. Sometimes these not-to-exceed levels differ among federal organizations because they used different exposure times (an 8-hour workday or a 24-hour day), different animal studies, or other factors.

Recommendations and regulations are also updated periodically as more information becomes available. For the most current information, check with the federal agency or organization that provides it. The U.S. EPA (2009) provisional drinking water advisory for PFOA and PFOS are 0.4 and 0.2 ï¿½g/L, respectively.

References

Agency for Toxic Substances and Disease Registry (ATSDR). 2009.
Toxicological profile for Perfluoroalkyls(Draft for Public Comment). Atlanta, GA: U.S. Department of Health
and Human Services, Public Health Service.

ATSDR can also tell you the location of occupational and environmental health clinics. These clinics specialize in
recognizing, evaluating, and treating illnesses resulting from exposure to hazardous substances.

Information line and technical assistance:
Phone: 888-422-8737

To order toxicological profiles, contact:
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5285 Port Royal Road
Springfield, VA 22161
Phone: 800-553-6847 or 703-605-6000

Disclaimer
Some PDF files may be electronic conversions from paper copy or other electronic ASCII text files. This conversion may have resulted in character translation or format errors. Users are referred to the original paper copy of the toxicological profile for the official text, figures, and tables. Original paper copies can be obtained via the directions on the toxicological profile home page, which also contains other important information about the profiles.

The information contained here was correct at the time of publication. Please check with the appropriate agency for any changes to the regulations or guidelines cited.